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Venting subcutaneous emphysema

Ronald Simon trauma-list@trauma.org
Tue, 08 Jan 2002 19:05:22 -0500 

I have a case i'd like your opinion on. Sorry for the multi listing but 
this problem crosses specialties.

A 48 yo woman victim of MVC. Has multiple rib fx, pulm contusions, R 
pneumothorax for which a chest tube was placed. Patient now several days 
out chest tube still has small airleak, lung is up on chest xray. She 
has over the last few days developed significant subcut emphysema of her 
chest and face. My collegue wants to place a mediastinal "vent" (small 
incision above the manubrium to allow the air to escape). This does not 
make sense to me but in trying to be open minded i'm wondering if this 
is a described treatment. As far as i'm concerned as long as the chest 
tube is controlling the leak, the SQ air is unsightly and has no adverse 
effects unlike making a connection between the mediastinum and the 
outside world.
Thanks for your input
Ron Simon, MD
Jacobi Medical Center
Bronx, NY